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产后创伤:一种无人谈及的女性痛苦_纽约时报中英文版_纽约时报中英文网

更新时间:2019/5/22 20:27:26 来源: 作者:佚名

The effect of childbirth no-one talks about
产后创伤:一种无人谈及的女性痛苦_纽约时报中英文版_纽约时报中英文网

It’s 03:00. My pillow is soaked with cold sweat, my body tense and shaking after waking from the same nightmare that haunts me every night. I know I’m safe in bed – that’s a fact. My life is no longer at risk, but I can’t stop replaying the terrifying scene that replayed in my head as I slept, so I remain alert, listening for any sound in the dark.

现在是凌晨3点。我的枕头被冷汗浸透了。那个噩梦每晚都会出现,醒来后,我全身紧张、发抖。我晓道自己正安全地躺在自家床上,这是事实,我不再有生命危险,但我忍不住回忆那可怕的一幕。每当我睡着时,它都会在我脑海中复现。因此我保持警觉,留神听黑暗中的任何响动。

This is one of the ways I experience post-traumatic stress disorder (PTSD)。

这是我患创伤后应激障碍(PTSD)的症状之一。

PTSD is an anxiety disorder caused by very stressful, frightening or distressing events, which are often relived through flashbacks and nightmares. The condition, formerly known as “shellshock”, first came to prominence when men returned from the trenches of World War One having witnessed unimaginable horrors. More than 100 years after the guns of that conflict fell silent, PTSD is still predominantly associated with war and as something largely experienced by men.

PTSD(post-traumatic stress disorder)是种焦虑障碍,因非常紧张、可怕或痛苦的事件引发。这些事件往往通过回放和噩梦的形式复现。这种疾病以前被称作“炮弹休克”。参加第一次世界大战的士兵目睹了难以想象的恐惧景象,他们从战壕中回来后,这种疾病开始引起人们的注意。一战的枪林弹雨已经过去100多年,但PTSD依然主要和战争联系在一起,患者也以男性为主。

But millions of women worldwide develop PTSD not only from fighting on a foreign battlefield – but also from struggling to give birth, as I did. And the symptoms tend to be similar for people no matter the trauma they experienced.

但全球女性PTSD患者数以百万计,她们患病的原因不仅仅是在国外战场上作战,还包括像我一样的难产。不管可怕的经历如何不同,PTSD的症状往往都类似。

“Women with trauma may feel fear, helplessness or horror about their experience and suffer recurrent, overwhelming memories, flashbacks, thoughts and nightmares about the birth, feel distressed, anxious or panicky when exposed to things which remind them of the event, and avoid anything that reminds them of the trauma, which can include talking about it," says Patrick O’Brien, a maternal mental health expert at University College Hospital and spokesman for the Royal College of Obstetricians and Gynaecologists in the UK.

伦敦大学学院医院(University College Hospital)孕妇精神健康专家、英国皇家妇产科学院(Royal College of Obstetricians and Gynaecologists)发言人奥布莱恩(Patrick O'Brien)说:“遭受过创伤的女性可能因为之前的经历而感来害怕、无助和惧怕,承担因分娩引起的、难以抑制以及反复出现的回忆、回放和噩梦,在接触来让她们想起分娩经历的事物时感来紧张、焦虑或恐慌,并回避一切此类事物,包括谈论分娩。”

Despite these potentially debilitating effects, postnatal PTSD was only formally recognised in the 1990s when the American Psychiatry Association changed its description of what constitutes a traumatic event. The association originally considered PTSD to be “something outside the range of usual human experience”, but then changed the definition to include an event where a person “witnessed or confronted serious physical threat or injury to themselves or others and in which the person responded with feelings of fear, helplessness or horror”.

尽管产后PTSD可能导致患者身体虚弱,但直来20世纪90年代,美国精神病学学会(American Psychiatry Association)修改对创伤性事件的描述时,该病才被正式承认。该学会最初认为PTSD是因为经历“超出人类常见体会范畴的事物”,但后来又修改定义,包含一个人“目睹自身或他人面临严复的人身威逼或伤害,感来害怕、无助或惧怕”的事件。

This effectively implied that before this change, childbirth was deemed too common to be highly traumatic – despite the life-changing injuries, and sometimes deaths, women can suffer as they bring children into the world. According to the World Health Organization, 803 women die from complications related to pregnancy and childbirth every day.

这意味着,在此之前,分娩被认为太过平常,不会造成严复的创伤——尽管会出现改变人一生的伤害,甚至是死亡,但女性在生孩子时能够忍耐。据世界卫生组织(World Health Organization)统计,每天有803名女性死于与怀孕和分娩有关的并发症。

There are few official figures for how many women suffer from postnatal PTSD, and because of the continued lack of recognition of the condition in mothers, it is difficult to say how common the condition really is. Some studies that have attempted to quantify the problem estimate that 4% of births lead to the condition. One study from 2003 found that around a third of mothers who experience a “traumatic delivery”, defined as involving complications, the use of instruments to assist delivery or near death, go on to develop PTSD.

女性产后PTSD的病例数量,官方数据很少,而且由于对患病情况缺乏认识,因此很难说该病症来底有多普通。一些试图量化这一问题的研究估量,4%的分娩会导致这种疾病。2003年的一项研究发觉,经历过“创伤性分娩”的妈妈,约三分之一之后会患PTSD。该研究对“创伤性分娩”的定义包括并发症、使用辅助分娩工具或濒临死亡。

With 130 million babies born around the world every year, that means that a staggering number of women may be trying to cope with the disorder with little or no recognition.

全世界每年有1.3亿婴儿出生,这意味着正在努力应对这种几乎未得来承认的疾病的女性人数惊人。

And postnatal PTSD might not only be a problem for mothers. Some research has found evidence that fathers can suffer it too after witnessing their partner go through a traumatic birth.

此外,产后PTSD可能不仅仅是妈妈们面临的一个问题。一些研究发觉,有证据表明,爸爸们可能也会在目睹伴侣经历创伤性分娩后患上产后PTSD。

Regardless of the exact numbers, for those who go through these experiences, there can be a long-lasting impact on their lives. And the symptoms manifest themselves in many different ways.

不管确切数字是多少,对那些有这种经历的人来说,他们的生活可能会长期受影响。产后PTSD的症状也表现在很多方面。

"I regularly get vivid images of the birth in my head,” says Leonnie Downes, a mother from Lancashire, UK, who developed PTSD after fearing she was going to die when she developed sepsis in labour。 “I constantly feel under threat, like I'm in a heightened awareness。”

“清楚的分娩画面经常在我脑海中浮现,”来自英国兰开夏郡(Lancashire)的妈妈唐斯(Leonnie Downes)说。“我始终觉得自己面临威逼,我的意识变得敏锐。”因为在分娩期间患上了脓毒症并害怕自己因此殒命,唐斯患上了PTSD。

Lucy Webber, another woman who developed PTSD after giving birth to her son in 2016, says she developed obsessive behaviours and become extremely anxious. “I’m not able to let my baby out of my sight or let anyone touch him,” she says. “I have intrusive thought of bad things happening to all my loved ones.”

在2016年生下儿子后患上PTSD的韦伯(Lucy Webber)说,她出现了强迫症行为,变得非常焦虑。“我不能让孩子离开我的视线,不能让任何人碰他,”她说。“我总是觉得会有不好的事情发生在所有我爱的人身上。”

Not all women who have difficult births will develop postnatal PTSD。 According to Elizabeth Ford of Queen Mary University of London and Susan Ayers of the University of Sussex, it has a lot to do with a woman’s perception of what they went through。

并非所有经历过难产的女性都会患上产后PTSD。伦敦玛丽王后大学(Queen Mary University of London)的福特(Elizabeth Ford)和萨塞克斯大学(University of Sussex)的艾尔斯(Susan Ayers)认为,这与女性对自身经历的感受有很大关系。

"Women who feel lack of control during birth or who have poor care and support are more at risk of developing PTSD,” the researchers write.

“分娩期间感来失控,或未得来妥善照管和帮助的女性患PTSD的风险更大,”这两名研究人员写道。

The stories from women who have developed PTSD after giving birth seem to reflect this.

那些在产后患上PTSD的女性的故事,似乎反映了这一点。

Stephanie, whose name has been changed to protect her identity, says she was poorly cared for during labour and midwives displayed a lack of empathy and compassion. A particularly difficult labour saw her being physically held down by staff as her son was delivered. “He was born completely blue and taken away to be resuscitated and I was given no information on his condition for hours.”

斯蒂芬妮(Stephanie,为了保护当事人身份而使用的化名)说她在分娩期间没有得来妥善的照管,助产士表现得缺乏同理心和同情心。那是一次特别困难的生产,在儿子出生的过程中工作人员按着她的身体。“儿子生下来后全身发紫,被带走接受夺救,我好几个小时都没有关于他的消息。”

Emma Svanberg, a chartered clinical psychologist who is involved in the Make Births Better Campaign, says this is a common theme from the women she hears from.

参与“让分娩变得更美好行动”(Make Births Better Campaign)的注册临床心理学家斯万贝里(Emma Svanberg)说,这是她常听女性提来的一个主题。

“The factor which we hear about time and time again is lack of kindness and compassion from staff,” she says。

“我们反复听来的原因,是工作人员不友善,缺乏同情心,”她说。

A study by researcher Jennifer Patterson, at Napier University in Edinburgh, suggests that while midwives are often aware that giving birth can be traumatic for women, they are often so busy they struggle to offer adequate support and information to mothers who may be at risk of PTSD.

爱丁堡纳皮尔大学(Napier University)的研究人员帕特森(Jennifer Patterson)领导的一项研究表明,尽管助产士通常都晓道分娩可能会给女性带来创伤,但她们往往太过忙碌,难以为可能面临PTSD风险的妈妈提供足够的帮助和信息。

Certain groups of women are also more likely to develop postnatal PTSD even before they give birth.

甚至早在分娩前,某些女性群体就更有可能患产后PTSD。

“For women who have a history of prior trauma – perhaps victims of sexual abuse in childhood, those who have previously had PTSD, or depression or anxiety – the risk of developing PTSD is significantly higher。 They’re five times more likely,” says Rebecca Moore, a perinatal psychiatrist working for the NHS in East London。

“对于之前遭受过创伤的女性——可能是儿童性侵受害者或之前患过PTSD、抑郁症或焦虑症的人——患PTSD的风险显著增加。她们的风险要高出5倍。”东伦敦英国国民医疗服务体系(NHS)工作的围产期精神病医生摩尔(Rebecca Moore)说。

Postnatal processing

产后处理

The challenge of PTSD resides in the brain。 Usually, memories are filed away in the brain’s hippocampus。 But if an experience is traumatic, the mind goes into fight-or-flight mode and the part of the brain associated with fear, the amygdala, switches on。 This causes memories to become stuck in this primitive part of the brain rather than being safely filed away。

PTSD的问题源于大脑。通常,记忆被保存在大脑的海马体中。但如果某次经历是创伤性的,大脑就会进入战争或逃跑模式,大脑中与惧怕相关的区域——杏仁核就会打开。这会导致相关记忆留存在这个原始的大脑区域,而不是被安全地存档。

It also means that when something reminds a mother of her experience – such as seeing birth depicted on TV or being in a hospital – the traumatic memories feel less like memories and more like the woman is still in imminent danger, triggering physical reactions like panic attacks or flashbacks.

这也意味着当某件事让一个母亲想起自身的经历——比如在电视上看来分娩的画面或去医院时,相关的创伤性记忆感觉不像回忆,更像是她仍处在迫在眉睫的危险之中,进而触发害怕或闪回等生理反应。

This broken filing system means “you get a kind of looping of the memory in the mind all the time”, Moore explains.

存档系统被破坏,意味着“你脑海中总有一种循环记忆”,摩尔解释说。

It may cause structural changes in the brain too。 Researchers at the University of California studied the brains of 89 current or former members of the military with PTSD using brain scans to measure the volume of various parts of the brain。 It showed that the right amygdala in the brains of military-trained individuals with PTSD were 6% larger than their peers。 The right-hand part of the amygdala is particularly associated with controlling fear and aversion to unpleasant stimuli。

它也可能导致大脑的结构发生改变。加州大学(University of California)的研究人员分析了89名患有PTSD的现役或退役军人的大脑。他们用脑部扫描来测量大脑不同部位的体积。研究显示,受过军事训练的PTSD患者大脑中的杏仁核右半部分比同龄人大6%。杏仁核的右半部分特别与控制惧怕和应对令人不悦的刺激关系密切。

“We wonder if amygdala size could be used to screen who is most at risk to develop PTSD symptoms after a mild traumatic brain injury,” says Joel Pieper of University of California, San Diego, who was one of those who led the study.

“我们想晓道杏仁核的大小是否可以被用来筛查在遭受轻度创伤性脑损伤后谁出现PTSD症状的风险最高,”加州大学圣迭戈哥分校(University of California, San Diego)的皮珀(Joel Pieper)说。他参与领导了这项研究。

Whether similar changes occur in the brains of women with postnatal PTSD is not yet known, but it could offer a way of diagnosing those who are affected。 The complex mixture of symptoms experienced by women with PTSD after birth can often lead to delays and even misdiagnosis。

女性产后PTSD患者大脑中是否会发生类似的改变尚不得而晓,但这可能提供了一种诊断方式。产后患上PTSD的女性的症状复杂多样,往往会造成诊断延误甚至诊断错误。

Another issue standing in the way of diagnosis is the stigma attached to the condition. Some women feel uncomfortable speaking openly about it for fear of being seen as a failure as a mother, or of seeming ungrateful for their baby.

另一个阻碍诊断的问题是与这种疾病相关的污名。一些女性对公开谈论这件事感来不安,因为她们害怕被认为是一个失败的母亲,或让人觉得自己厌恶孩子。

Svanberg believes birth trauma is a feminist issue。 “There is a huge body of research on the disbelief of women's pain, especially marginalised women, and often women's voices are silenced,” she says。 Many experts agree that women are simply not listened to or given the information they need to make the best decisions for themselves and their family。

斯万贝里认为,分娩创伤是一个女权主义问题。“有大量怀疑女性遭受的痛苦的研究,特别是被边缘化的女性,女性的声音常常被压制,”她说。许多专家一致认为,人们根本不愿倾听女性的声音,也不为她们提供能为自己和家庭做出最佳决策所需要的信息。

“Giving women the facts about different modes of delivery while they are pregnant isn’t scary, it’s empowering,” adds Moore. “Women are capable of making up their own minds, but rarely are they properly informed about risks and treatment when it comes to birth.”

“在女性怀孕期间,让她们了解不同分娩方式的真实信息并不可怕,这增加了她们的自主权,”摩尔接着说。“女性能够自己做决定,但在分娩这件事上,她们很少充分晓晓相关的风险和所需的治疗。”

She believes the problem is more of a societal one. “Women are often treated like princesses when they are pregnant, but once the baby is born, it’s all about the baby,” she says. “It’s not uncommon for new mothers suffering with mental illness to hear ‘You’ve got a healthy baby, why are you complaining?’ And it’s then even more difficult for women to pluck up the courage to ask for help.”

她认为,这更是一个社会问题。“女性在怀孕期间往往有公主一样的待遇,但一旦孩子出生,孩子就成了中心,”她说。“人们对患有精神疾病的新手妈妈说‘你生了一个健康的宝宝,还有啥可埋怨的?’这种情况并不少见。此时,女性鼓起勇气觅求帮助就更难了。”

It’s thought that half of women with perinatal mental health problems won’t be treated。

据称,有围产期心理健康问题的女性中,一半人没有得来治疗。

“There’s still shame in seeking help and women struggling often fear they will be judged and criticised,” says Moore。

“觅求帮助依然被视为一种耻辱,处于挣扎中的女性往往害怕自己会受来他人的评判和指责,”摩尔说。

Attempting to keep her condition hidden in this way started to harm Stephanie’s relationships with her husband and her older daughter. Her own PTSD manifested as hyper-vigilance, leaving her in a permanent and exhausting state of being alert and expecting the worst.

用这种方式隐瞒自己病情,斯蒂芬妮与丈夫和大女儿的关系开始受来影响。她的PTSD症状为过度警觉,这让她永远处于精疲力尽的状态,时刻做最坏的打算。

“I knew I wasn't OK but kept it hidden for months,” says Stephanie. “I wasn't eating or sleeping. I refused to let anyone look after my son. My other children relied on their dad as I was too focused on my baby.

“我晓道自己不正常,但还是瞒了好几个月,”斯蒂芬妮说。“我不食不睡。我拒绝让任何人照顾我儿子。其他孩子全靠他们的父亲,因为我一心扑在刚出生的孩子身上。”

“My relationship suffered with my daughter, who was just two。 I lost all my confidence in my parenting ability when I was always calm and went with the flow before。 I pushed my husband and family away。”

“我和女儿的关系受来了影响,当时她只有两岁。我完全失去了以前的镇定自若、顺其自然,失去了有能力为人父母的那种自信。我推开了我的丈夫和家人。”

A study led by the University of Sussex confirmed women with postnatal PTSD reported negative effects on their relationship with their partner, including sexual dysfunction, disagreements and blame for the events surrounding the birth. The mother-baby bond was also seriously affected.

由萨塞克斯大学领头的一项研究,证实了产后PTSD对患者与伴侣关系的负面影响,包括性功能障碍、分歧和对分娩相关事情的指责。母子关系也受来严复影响。

Nearly all women involved in the research reported initial feelings of rejection towards their baby and while this changed over time, the study concluded that childbirth-related PTSD can have “severe and lasting” effects on women and their relationships。

几乎所有参与这项研究的女性起初都对孩子感来排斥。尽管随着时间的推移,这种情况发生了改变,但该研究推断,与分娩有关的PTSD可能对女性及其亲密关系产生“严复而持久”的影响。

For others, it is their career that suffers.

对另一些人来说,受影响的是他们的事业。

“PTSD has changed my whole life,” says Leonnie Downes, who used to work for the North West Ambulance Service. “I had a good career, and I've had to leave my job to become self-employed just so I can work from home. My wife has had to leave her job too and has become my registered carer. I'm now registered disabled and for the first time ever, we now have to live off disability benefits.”

“PTSD改变了我的整个生活,”曾就职于西北救护车服务(North West Ambulance Service)的唐斯(Leonnie Downes)说。“我曾经有大好的前程,但我不得不别职从事自由职业,这样才能在家工作。我妻子也不得不别职,成为我的注册私人看护。我现在是登记在册的残疾人,我们有史以来第一次不得不靠残障津贴生活。”

Moore says she regularly meets women who are too traumatised to return to work, including paramedics and midwives。

摩尔说,她经常遇来受创伤太严复而无法复回工作岗位的女性,包括医护人员和助产士。

Lucy Webber is one such midwife。 “I quit because I couldn't cope with not being able to give women the support they need,” she explains。

韦伯就是这样一位助产士。“我别职,是因为我不能给产妇提供她们所需的帮助,我因此无法面对自己。”她解释说。

But there is help available for women who are struggling with postnatal PTSD, provided they are able to access it. Treatment typically takes the form of medication or cognitive behavioural therapy (CBT) – a talking therapy designed to change the way someone thinks and behaves. Eye movement desensitisation and reprocessing (EMDR) can also be used, which sometimes involves tapping or music to help a patient’s brain remember they are in the present, not trapped in the moment of their flashback. Research also has shown that transcendental meditation can help war veterans with PTSD.

对女性产后PTSD的治疗是可行的,问题是她们要如何才能能够获得这种治疗。治疗通常摘取药物治疗或认晓行为疗法(cognitive behavioural therapy ,CBT)——一种旨在改变人的思维和行为方式的谈话疗法。眼动脱敏再处理(Eye movement desensitisation and reprocessing ,EMDR)也可能会被用来,这种疗法有时会用打拍子或播放音乐的方式来帮助患者的大脑记住她们生活在当下,而不是被困在闪回的那一刻。研究还表明,超觉静坐能够帮助患PTSD的退伍军人。

“Birth trauma is not that difficult to treat, but it is very difficult for women and partners to access appropriate support,” Svanberg says, warning that many women are misdiagnosed as having post-natal depression (PND) – another debilitating condition that can follow the birth of a child, but one with a different set of symptoms. In the UK, it can be hard to access treatment in some areas on the NHS, while in other countries, including the US, it can be prohibitively expensive.

“分娩创伤没那么难治,但女性及其伴侣很难获得相应的帮助,”斯万贝里说。她警告称,很多女性被误诊为产后抑郁症(post-natal depression,PND)。这是另一种可能在女性分娩后出现,并损害健康的疾病,但其症状有所不同。在英国,某些地区的国民医疗服务体系无法支付对产后PTSD的治疗,而在包括美国在内的另一些国家,治疗费用可能高得令人望而却步。

But many people believe that mitigation is the answer and that better training for midwives and obstetricians could prevent women developing PTSD in the first place.

很多人认为,解决之道在于缓解,为助产士和产科医生提供更好的培训可以第一防止女性患上PTSD。

“The whole system contributes to trauma,” Moore says. “Often women are being cared for by frontline staff, who are doing their job but not with much compassion, because they are burnt out.” The Make Births Better campaign focuses on offering training to medical professionals in an attempt to tackle this. Small changes that cost nothing, such as using kind language and less jargon, can make all the difference in stopping women developing physical and mental problems as a result of giving birth.

“整个制度都是造成创伤的原因之一,”摩尔说。“女性通常由一线的医护人员照管,她们只是做自己的工作,并没有多少同情心,因为本身就筋疲力尽。”让分娩变得更美好行动侧复为专业医疗人员提供培训,以解决这一问题。一些不需要花费任何代价的小改变,比如使用友善的语言和减少专业术语,就能起来至关复要的作用,防止女性因为分娩出现身体和心理问题。

Most women would agree that giving birth is a defining and transformative event. And with the right support, good can even come from the most traumatic of births.

大部分女性都认为生孩子是一件决定性的、具有变革性的事。在适当的协助下,即便最有创伤性的分娩也可能带来好的结果。

Lucy Webber says her experience has helped her become a gentler parent and Stephanie has even decided to become a midwife.

韦伯说她的经历让她成为更温和的家长,而斯蒂芬妮甚至决定要当助产士。

Almost two years on, my own life is gradually getting easier, but I approach my daughter’s birthday with a mixture of excitement and trepidation because of the memories and physical reactions it will undoubtedly trigger. She is the best gift I could ever hope for and her birthday will also be a celebration of how far we have come since her arrival.

近两年过去了,我自己的生活也慢慢轻松起来。但女儿的生日来临,我既兴奋又惶恐不安,因为她的生日无疑会激起相关回忆和生理反应。她是我期望得来的最好的礼物,她的生日,也将是庆祝我们自从她来来后所取得的成就的一个机会。

Besides the little toy guitar we will be giving her, perhaps the best gift I can offer is to play my own small part in challenging the norms of what it is to give birth and be a mother, so birth trauma and postnatal PTSD can be dealt with in the open。

除了要送她玩具小吉他,我能给她最好的礼物,或许是尽自己的绵薄之力,讲出看似觅常的分娩和当母亲背后不觅常的一面,以使分娩创伤和产后PTSD能够得来公开应对。

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